February 12, 2015
Movement analysis is a powerful skill. When we are able to analyze a movement and see where a child is having difficulty, then we gain valuable information regarding where we should be targeting our intervention. Movement analysis is one way to gain information about the “why” questions; why does a child move that way, why is a child having difficulty achieving this milestone….?”.
Just before the holidays, a mom posted a great Youtube video of the progression of crawling for her son. I used it to analyze his movement progression through each stage for my Tuesday Tips on the HeartSpacePT Facebook page. A therapist asked if I would put all those posts together in one place, so here they are.
Let’s begin with the “Failure to Launch”portion of the video. The baby has central stability (as noted from his alignment and breathing pattern), some pretty good activity of the POS (posterior oblique synergist = contralateral lats and glute max) and AOS (anterior oblique synergist = contralateral abdominal obliques and adductor), all in the prone position. However in prone you can see that the LEs are still abducted and slightly externally rotated, which predisposes activity of hip extension (which is lovely) but not balanced with hip flexion activation and therefore maintaining the 4 point position is a challenge. So as he pushes back from prone to try to get into 4 point, he may be breath holding (indicating central stability is challenging) and the hips remain extended. Consequently he loses control over his right side which, in this alignment, provides only a narrow base of support.
In “Reversal of Fortune” the pushing backwards movement activates the POS in a big way while not increasing the gravitational challenge to central stability. Also, at the end of the movement, the baby attempts to engage more trunk flexion to balance the POS activity but uses primarily the rectus abdominis (as indicated by the tucking of the chin and lumbar flexion) so he is unable to get his knees under his hips without activation of the psoas and ends up in prone again.
“Face Plant” is perhaps one of my favourites. The baby begins to activate more upper trunk flexion by pulling himself forward in prone. He also activates more hip flexion to get his knees closer under his hips. There isn’t yet sufficient stability to create a relationship between the shoulder girdle and pelvic girdle (through the POS and AOS activity) so hip extension overpowers flexion and he ends up with his weight on his upper chest and head!
“Mr Tipsy” displays an improvement in central stability in 4 point but it’s tenuous as he’s wobbling around midline. And when lateral weight shift adds to the postural demand, the POS (L lats and R glute max) cannot maintain the position (as the inner core does not provide a sufficient anchor) and he falls.
“The Wounded Soldier” – mobility alert: our little guy has organized forward mobility! Again, postural control has organized in a position that is less postural demand, in this case prone rather than 4 point. Central stability is in place and is reinforced by activation of balanced anti-gravity extension and flexion. He is leading with his right shoulder and left leg, indicating that the POS and AOS on the right side are slightly more coordinated in their action than the left.
In “Army Crawl”, our baby organizes coordination between the two sides of the body. He maintains central stability and we begin to see the more complex movement component of rotation of the trunk around a stable center rather than lateral weight shift, indicating a progression of central stability and complex timing/activation of the POS and AOS. Mature control of rotation is essential for the development of balance and bilateral function.
“The Engine Revver” – our little guy gets his posture together in 4 point. He’s practicing here, integrating his STNR, maintaining central stability against gravity, and activating his POS and AOS bilaterally in preparation for lateral weight shift.
In “The Wobbly Sailor” we can see that his pelvic stability during weight shift is a little, well, wobbly. The diaphragm-pelvic floor piston (see Julie Wiebe PT for a complete discussion of these concepts) isn’t providing quite enough stability from the inside-out just yet and his lateral synergist (contralateral glute med. and adductors) isn’t efficient. He is utilizing a lateral flexion pattern at the trunk rather than rotation.
“The Speed Freak” is almost there! Now there is speed of weight shift and forward progression with good central stability which includes better pelvic stability. However, his arms remain internally rotated and his scapula appears abducted, indicating that there is still some inefficiency of stabilization of the shoulder girdle. And indeed, one of his arms flexes too far mid-crawl and he goes to ground.
“The Professional” has it mostly together. I would suggest that this is not as efficient as he will become, as the arms are still quite internally rotated and he is still using lateral flexion at the trunk rather than the more mature rotational pattern.
That’s it – we’ve completed our movement analysis of this little guy crawling. Breaking down a skill like this gives us information about how/where a client is having difficulty with functional movement and is the first step in clinical problem solving.
If you find this process difficult, take a short video during a client session and analyze it later when you can replay it as many times as you wish. Like our little guy here, practice will make you faster and more efficient!